Individual
KIMBERLY DALE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4820 EAST MAIN STREET, SJRMC URGENT CARE, FARMINGTON, NM 87402
(505) 609-6495
(505) 609-6496
Mailing address
PO BOX 4002, DURANGO, CO 81302-4002
(970) 884-0548
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
32573
CO
207P00000X
Emergency Medicine Physician
Primary
MD2009-0511
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01325737
—
CO
05
—
K5584
—
NM
Enumeration date
07/25/2006
Last updated
10/14/2012
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